1. Waldenström's macroglobulinemia (WM)
Treatment pathway
Waldenström's macroglobulinemia
(WM)
Author: Dr Nagesh Kalakonda,
Consultant Haematologist, on behalf of the Haematology CNG
Written: March 2011
Agreed by CNG: April 2011
Review Due: April 2012
References:
1. NEPARIDZE, N., DHODAPKAR. M. (2009) Waldenstrom’s Macroglobulinemia:
Recent Advances in Biology and Therapy; Clinical Advances in Hematology & Oncology Volume
7, Issue 10, October
2. TREON.S, (2009) How I treat Waldenström macroglobulinemia BLOOD, 17
September Volume 114, Number 12,
3. DIMOPOULOS M ,GERTZ M, KASTRITIS E et al (2008) Update on Treatment
Recommendations From the Fourth International Workshop on Waldenstrom’s
Macroglobulinemia; Journal of Clinical Oncology; published online
Page 1 of 2

2. Consider plasmapheresis
Asymptomatic
Observation
q2-3 mths yr 1
q3-6 mths > yr 1 WM
Progression
Symptomatic
ASCT ineligible
Single agent
Chl., F, or Cladribine
ASCT eligible
Progression
R-CP or R-CD or R-CVP or R-CHOP #
Progression
Progression
Re-use R-CP or R-CD or R-CVP or R-CHOP
if ≥ 2 years
BDR* or R-Bendamustine
or R-Thalidomide (If no history or evidence of VTE)
Progression
Progression
Consider Campath
Progression
Consider plasmapheresis
at all stages
Salvage + ASCT**
Chl. – Chlorambucil, C – Cyclophosphamide, R – Rituximab, F – Fludarabine
P – Prednisolone, D – Dexamethasone, H – Doxorubucin, VTE – Venous Thrombo-embolism
# R may cause IgM flare which can last a few months. May need to consider omitting for 1 -2 courses
*BDR – Bortezomib + Dexamethasone + Rituximab (Particularly useful for rapid reduction of
IgM levels). Funding requests for 2 cycle blocks (to a maximum of 8 cycles) subject
to demonstration of objective and ongoing response(s).
** May need to be considered earlier in the pathway in the event of rapid progression + younger
age or high grade transformation. An allograft may be considered in very select situations.
MCCN WM treatment pathway, April 2011 (due for review April 2012) Page 2 of 2